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HomeMy WebLinkAboutBLD2009-00050 UILDING PERMIT APPLIC . ON Review Type: Jefferson County Department of Community Development MLA09-00051 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00050 Received Date: 2/23/2009 SITE ADDRESS: 204 WOODLAND WAY PORT TOWNSEND, 98368 OWNER: DENNIS E MC DANIEL PHONE: 360-385-5847 TRUE HEART 204 WOODLAND WAY PORT TOWNSEND WA 98368-2818 MARVIN GARDENS SUBDIVISION: Block: Lot: 3 PARCEL NUMBER: 001345006 Section: 34 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI NSFR W/ATT GARAGE & A/G 500 GAL PROP TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 2,551 VALUATION 260,951.00 ADD'L: HEAT TYPE: RAD CODE EDITION: 2006 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: 169 SHORELINE: CONST TYPE: GARAGE: 378 SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: OTHER BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 3 Total: 2 Total: _--3_ --- _I) Routing Date: -T -- Type Amount Paid By: Date: Receipt: APPOVED ePermit $1,895.35 LYK 02/23/09 105456 Plan Check $1,231.98 LYK 02/23/09 105456 State Building Code $4.50 LYK 02/23/09 105456 APR i 2009 Potable Water Application $62.00 LYK 02/23/09 105456 Jefferson County Plannini Total: $3,193.83 &Building Department Jefferson County Building 410. Permit NuOr: BLD09-00050 Applicant: MC DANIEL BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Codes To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Setbacks Setbacks A f,C Minimum setback from Woodland Way right-of-way shall be 20 feet. ��_ ` Minimum side and rear yard setbacks shall bo 5 feet. Erosion Control SEE CONDITION 2 FOR CONSTUCTION ENT. STABILIZATION Erosion Control Foundation Footing 4127 -_(\ i te Footing Drains ,^t_off^ Foundation Stem Wall _ai Underground Plumbing , F Under Floor Framing D -�I►3/01 Straps(hold downs) Ext. Shear Wall Nailing (v l��c Rough in Plumbing 7:2(-Oct Framing `� C Blocking ° �� Airseal _ Insulation: Walls (2` 1, 1-661 Insulation: Floors J et 0CC F`, Insulation: Ceiling 4 2 9_ Int. Shear Wall Nailing Wallboard Nailing Gas Line: Interior Gas Line: Exterior , , • 3-40e Propane Tank Z , b 04 Heat/Chimney Clearance gL, 4 _o0( `LLD Drywell/Alt Drainage Drywell/Alt Drainage ,4.' p SEE CONDITION I FOR DRYWELL SPECS. Address Posted \ Atti— FINAL INSPECTION 22.4,I FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR CONDITIONS for Building Permit# :BLD09-00050 1.) 2005 DOE STORMWATER MANUAL DRYWELL DESIGN CRITERIA ALL INFILTRATION SYSTEMS SHOULD BE AT LEAST 10 FEET FROM ANY STRUCTURE, PROPERTY LINE, OR SENSITIVE AREA. FOR SITE WITH SEPTIC SYSTEMS, INFILTRATION SYSTEMS MUST BE DOWNGRADIENT OF THE DRAINFIELD UNLESS THE SITE TOPOGRAPHY CLEARLY PROHIBITS SUBSURFACE FLOWS FROM INTERSECTING THE DRAINFIELD. DRYWELL BOTTOMS MUST BE A MINIMUM OF 1 FOOT ABOVE SEASONAL HIGH GROUNDWATER LEVEL OR IMPERMEABLE SOIL LAYERS. EACH DRYWELL MAY SERVE UP TO 1000 SQUARE FEET OF IMPERVIOUS SURFACE FOR EITHER MEDIUM SANDS OR COURSE SANDS. TYPICALLY DRYWELLS ARE 48 INCHES IN DIAMETER (MINIMUM)AND HAVE A DEPTH OF 5 FEET (4 FEET OF GRAVEL AND 1 FOOT OF SUITABLE COVER MATERIAL). FILTER FABRIC (GEOTEXTILE) MUST BE PLACED ON TC)P OF THE DRAIN ROCK AND ON TRENCH OR DRYWELL SIDES PRIOR TO BACKFILLING. SPACING BETWEEN DRYWELLS MUST BE A MINIMUM OF 4 FEET. 2.) CONSTRUCTION ENTRANCES SHALL BE STABILIZED WHEREVER TRAFFIC WILL BE LEAVING A CONSTRUCTION SITE AND TRAVELING ON PAVED ROADS OR OTHER PAVED AREAS WITHIN 1,000 FEET OF THE SITE. THE ENTRANCE SHALL BE CONSTRUCTED ON A FIRM COMPACTED SUBGRADE. QUARRY SPALLS (OR HOG FUEL) SHALL BE ADDED IF THE PAD IS NO LONGER IN ACCORDANCE WITH THE SPECIFICATIONS. (BMP C105, 2005 DOE STORMWATER MANUAL). ANY SEDIMENT THAT IS TRACKED ONTO PAVEMENT SHALL BE REMOVED BY SHOVELING OR STREET SWEEPING. THE SEDIMENT COLLECTED BY SWEEPING SHALL BE REMOVED OR STABILIZED ON STIE. ANY QUARRY SPALLS THAT ARE LOOSENED FROM THE PAD, WHICH END UP ON THE ROADWAY SHALL BE REMOVED IMMEDIATELY. UPON PROJECT COMPLETION AND SITE STABILIZATION, ALL CONSTRUCTION ACCESSES INTENDED AS PERMANENT ACCESS FOR MAINTENANCE SHALL BE PERMANENTLY STABILIZED. 3.) A 30' SETBACK SHALL BE MAINTAINED FROM THE DISPOSAL COMPONENT TO ANY DOWNSLOPE FOOTING, CURTAIN OR INTERCEPTOR DRAIN OR DRAINAGE DITCH. A 10' SETBACK SHALL BE MAINTAINED FROM THE RESERVE AREA TO ANY UPSLOPE FOOTING, CURTAIN OR INTERCEPTOR DRAIN OR DRAINAGE DITCH. REQUIRES VERIFICATION ON RECORD DRAWING FOR SEPTIC SYSTEM. 4.) PRIOR TO OCCUPANCY & BUILDING FINAL - FINAL APPROVAL OF SEPTIC SEP08-00209 IS REQUIRED. MUST MEET ALL CONDITIONS OF SEPTIC PERMIT. 5.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 6.) A Stormwater Site Plan has be.bmitted and approved by the Department. Community Development. Once me subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 7.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 8.) Not more than 2 unlicensed vehicles shall be stored on any lot unless totally screened from view of neighboring dwellings and rights-of-way. Such screening shall meet all applicable performance and development standards specific to the district in which the storage is kept, and shall be in keeping with the character of the area. Screening shall meet the requirements of Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor vehicles is prohibited except in those districts where specified as an automobile wrecking yard or junk (or salvage) yard and allowed as a permitted use in Table 3-1 or Chapter 18.18 JCC, and such storage shall meet the requirements of JCC 18.20.100, Automobile wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor vehicles be stored in a critical area. 9.) This parcel is within the Kala Point no shooting area per JCC 8.50. 10.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 11.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 12.) The building height is not to exceed 35 feet. 13.) Minimum setback from Woodland Way right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 14.) Exterior lighting for residential uses shall not exceed twenty feet (20') in height from the finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. 15.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. w r • •- . ON L, lerlIV, JEFFERSON COUNTY � DEPARTMENT OF C� OMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 44qs O� 360/379-4450 . 360/379-4451 Fax krINO http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# O'---5I PROJECT/APPLICANT NAME'L N".n.3 kfc0, iviEL-2i-ce /T-f}-R- Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separate stormwater site plan map. Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. (2731 142) ler _ is Ii`iDi`. niO i) -rO 1zi.4_iLD P1 P/ziIVXA 7 is SirJrNC FC.JIK f\ g-Er1i-t0 Co'-&Pi-£ — Tit f ?-f 1 S A S i ov G L P.--rTA C r-4 r fD G R 9-AC:- �. p.m D G ra=rt N©4 S c.IN A-pi 1`s i S r s NC CLEA se-i1Vc AD..ir)eE fir r TT:) Air ExrS-rtTIC+ Gi prtQi✓L Dili% "-/.c ' . Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. -114 s A`12-E.s /,/-erg A song.;H F' t i N.E S L C)1'c /�U.✓-,i c y i-L. 7- 'r Q'ii `rt E E N - T H 1 i2 D i%AC D a..2,e r F � , - >.' SG-c.)f'r_t'J OYd' 17-i-t£. 5 6. "rr i i is 0 _A Ti 0 Mf,t=e- 5, 6 E P 7 .s L Ci G>z_.O O'rt -rt-e 3 co r I-4 i r2..D, u]i t 1-1 14 n -- A or L. i T r'-.,f s c P E p-N Tti£ N l t.) c cre-I- E 2_, 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. 1 H 0.,z2 rS ftn:4-D rz-o-HE A'-C' ' -r N E. N C)R----N 5 c D /:a L Cr-N(... (... .)O L:C)L"-NI) 1.../'c7 A+.e c SC A -rt i2.e�.,rD 7-"r t i2.Elvc-G.,A:'z--T A iv H e i2 0Ti 'T 1-t e .S 1-c.� c,c r'� ' ( S AL-SO M1 --:J i1 (iO-.-/7r,s (TLD), L.c.)ra. O (,r2.i\!:.S cc-.i'F-.2S -t-Ftg_. SiL SL0Pt= - 4. Describe the existing soils. Indicate soil type on the site map. S I'--H () y L.C) f�-i/t 5. Describe the existing site hydrology(i.e., drainage; behavior of water on the site—above, below, and on the ground). Indicate existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if applicable,and indicate acreage of each. LO T 3 C-F AR.A i2-1./ N G/ti..'2-O E "f S. 1 S O C,a,7 ( 0 OM A SCrc.-e i-+-I iCA.c r oc, 5 t-r)P 6- i4-7 i-r-r.-1 WO E. J 1 D c ri ire._ p iC i Lx_.}.i o ;_ 'i= F 12_49- t-t i C,c-i 2.2 G( os.-N.D, .-i---0 r i . z127 .-,..,>G �c--- ,1-Ki. D .5-1-", i' PROVED 6. DescribeA any excess levels of noise generated by the proposed use or activity: STORMWATER PLAN \I I ,.... '-,._ ,— 0.0.. C c:,-Psi S 1-- r2-4A C ,—i 0-74 MAR 1 2 2009 L Stull mW ' s Req Ill JEFFE• • ;'U DEPT.OF CO, /C6,,,, 1t' F, T SIGNATIIR : I t��_.�� 'r stormwater site plan template-rev.10/21/2008 / I 5 • • 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes, etc.)on the site. Indicate location on the site map. r t C S Tr:LC. t4 /a S S cry 8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads, and sensitive/critical areas (streams,wetlands, lakes, steep slopes,etc.). C 2 jig--/C lDt LLB, S N 5 t T i t)c'- / c2- A S ltr)J A C_ c:). , r' S / - A L R.f /' CD y i]1 tJ c ` f�r b yl v S i L�J 1 T'1-t (_ , - ' t S pctt +� R ii-✓ 2s Z P-C), .O,S Permanent Stormwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs and facilities to remain in place after construction of the project is completed. "Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control facilities are not exceeded. g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30 in the Manual) or, if not, what types of stormwater flow control will be utilized for the site or specific threshold discharge areas within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. Pvt.-.-- ex72_-^:t_,-----r—v_.Z... 1-4-77 13 i p l5 l'")El /Z. s7 �' , lLN D-62-/K-�'� 10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for"large"projects or projects that involve the potential for dispersion of contaminants.] f t E ,-Cry -cam/t-'l' . f - L./.7 / t_ L. 13 k. C 14 ,a n� r� t. c. f 7 r_`JU c, r2 -r 1-t,a_ D 12_7 E L. Z. S 11. Describe the performance goals and standards applicable to the project. r3 /AA. PA c-r € t7 /\ S L.-. , -r i Le" AS PUS S I $c c v t=-e? e-t 5 1-4-.."--/ (� 3 ice'c_ /sv s A L, V,r N F.v C L o-N. L�r c�p e ,k+v f. try; , H n(C R- tt / 4.c--L G e A i , f-4 ,-) r►O p s . r1- tke4 .�c ,2 *i n 1-1 Li 12, Describe the flow control system. L r--- E L. F.T LAN a-c. !-..>e - - C, c T/ ) , rits.NS iiCrl✓;O� �i,CLL C7 pf; SiLo-�v, A T. L.L rZ.h..L.. L 11 t stormwater site plan template';rev.10/21/200p 6 • • 13. Describe the water quality system. sir /S G e ;/ ,.LA-L 4-7 D 12. K>-,'r / N'E J�2 A-N7' .S"-TA--iv N ,211/N Gu'.4-"r 2 : f/�a.�s� (S' ivo t a_G- L/ 4-1-7 h .'If /'' 2-t-1-7--/EJ 7Y 'i- c X C c-C_.t� �. I�-r/✓� G r_A -/ /=c- P" ;4 C_ " r/ T IJ/2_A-/ E 14. Describe the conveyance system analysis and design. 0 4. c g. ozey 15. Describe the source of fill material, physical characteristics of fill material, and deposition of excess material. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. C'a r t r? A-c__ 17. Describe the proposed surfacing material. /y , , A-v E" cu. 18. Describe methods for restoration of the site. NC"p2 �L.v'Lcl'rr- ,Z. 6 "7e--c f= h 3 ©re- L. A-r4 +J -S C,iR--'ro i ✓-i L fZ E.S �"�L. —ri &- A-,2—.A /1 2 e9-e4---P,i E7 -i-�/ H c�r-�5 A L. t">T H F/2. A-; - r A S -t-b j3 L1= :_"T )!A "7--'r�-2-04c t w' r-ri l N A T 1 l/e. l-) L T 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [Thip is normally required for "large"projects only and only those for which facilities are required to control flow or treat runoff.] If included, list the Manuals here. ►.t/A 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. NI v 6a • 21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or restrictions here. �-� p'T 7 C iv S i L* a /s- iv 0 /4 & - D //V Cri T A nl != A t % E A D7' it P . stormwater site plan template-rev.10/21/2008 7 • • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN (SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at Volume II Section 3.2.3 of the Manual (beginning on page 3-7). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. P S 2. Establish Construction Access. R i v F .v/k y R c'G C.-.S s=t._ .r2 ' -t0 Y . -r p r3 c /S M 0 • 3. Control Flow Rates. D. 2__A i h 5 >-i A-.- . _!z_A y -O ,S • 1,+ S 4. Install Sediment Controls. 2. C F IZ/ , G 2-(l-t-4--1`+ C zl c_/2 - L. I I N i t C d YE N 1 C 5. Stabilize Soils. '7)t 1�. -' C j O C'Crt_.)--V ,Z.., 6. Protect Slopes. AL i_ Tr1i / S 5 i c I`A-Cr'z-c> > is"7—/ 1�1G e1.. r- E� & 2 ss r, i � 7. Protect Drain Inlets. L/ F. /2r /a C (2 25. 5 LIZ—) c-Z) '- I L-c_ R-4E. A&/a-r i T i S S , ANy stormwater site plan template—rev.10/21/2008 8 • • 12 Required Elements-Construction SWPPP(continued) 8. Stabilize Channels and Outlets. N/ A 9. Control Pollutants. 'tiro Nl r= v-re_..r S Y N • 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 12_ 12—E 11. Maintain Best Management Practices (BMPs). /2 2 T �}§`t S 1 .Y f�T Lk C �— —7—"/ /P/L rr S.- 12. Manage the Project. I e21' T k t,-4 S D —2—i Iv G C e) Tr S -r—Q LC. r co iv S r 1-i c ( t ! J i ►.i • —,'-'z.— (X %A c �["T u..,Z- A-p 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). N/ A b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. a • ....,.,,,..titer site plan template—rev._10/21/2008 9 i b. Description of special requirements for working in or near environmentally sensitive areas. 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils (e.g.,erodibility, settleability, permeability,depth,texture, soil structure). N/A N r 5. Construction Phasing. a. Construction sequence (AA-"-rz -0.S') // c--, Piz-r. P X. C'i ✓r"-1-• tr r�l r t_D c-"i r= 12."--rv.r l cz, irZ-O&F 1,l, - i J I N CL P t 4.-4-"A-Zs.1 14 G ti. L E: L -r 2 0 C'A L , F Iv S cc-i_ A:T_,O N /27 i`J A-t- i b. Construction phasing (if proposed) (""-r - JE. 0 9 ) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction schedule. 15/t ' I' ;Z.� ;� !=Er<-ca `D A---r-t rrr'& ( ' A fz - A P 12-Q 9) i= /2- ,., G, (APB -MAy •-02) jJL LLIk/l3 , N6, ErL .c:-rre__,C ( M�y - ,f:A.-1v 0-9 ) II. Wet Season Construction Activities. a. Proposed wet season construction activities. TVA . b. Proposed wet season construction activities for environmentally sensitive areas. N A 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. D& 1 s /',l( I)A- r l� �, T � �� N rzT. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. ;2.5 L_ t2--z. S p G'7V C r i3 / L. 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. 1`11/4 b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations stormwater site plan template—rev,10/21/2008 10 • • Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes, and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems, treatment facilities, flow control facilities, or structural source control BMPs (not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. C t' • / /0 9 (LANDOWNER OR AUTHORIZED REPRESENTATIVE SI NATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormwater site plan template—rev.10/21/2008 12 J (1---. °14-4,.. JEFFERSOf3UNY` ,t al DEPARTMENT OF COMMUNITY DEVELOPMENT `' `4 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 4-Is, p" . www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Caq _5 1 Project Description(include separate sheets as necessary): Akink-iavi N GA20E v s I-or 3 it�,C.i AA/I-Ay 2Es' OE At+4E a 0L4 cc Ioc_A--M0 t-t Ar -, ?,,2 `o TLi--;.AsE xi y 368 Tax Parcel Number: 0 6 / 3 y S 006, Property Size: .3 AC.2-e.5 (acres/square feet) Site Address and/or Directions to Property: Wen'ac A"'1 Die, vv 'ro i-Jav oc-.4-*•n Lc..1", ZC.) L{ (/(. 0i-A-Nv LCJ�-� l�0 re- ! 49 iv Spiv t' l.,(///4 9 g 3 G _ Property Owner(s)of Record: DE nr N i s E :AAc DA,-nt t. A-n 0 --1-2u-.t 4 E A ir'"- Telephone: 36C7- 3 8 5- 5S 4 7 Fax: email: o(e 1a,•s a rttcda-xiel' f) Mailing Address: 2-04-( t,voopc_"--ntp UJA<.y , po,zr-T-6,..L,Ncsei.k.D. u../A983CSr o ype+c..caa'.. Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies 18113uilding 0 Critical Areas Stewardship Plan ❑ Demolition Permit ----- ❑Variance(Minor, Major or Reasonable Economic Use) I Single Family i�'Garage(Attached/Detached ❑Conditional Use[C(a),C(d),or C]** n ❑ Manufactured Home ❑ Modular `" 0 Discretionary"D"or Unnamed L(s6 Clartsiicatldau ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑ Home Business ❑Cottage Industry 0 Binding Site Plan** 'FIDPropane 0 Long Plat** ❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre-Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any re.u' -d later inspections taffs access and right of ent will be assumed unless the applicant informs the County in writing at the time of the appf ation th. he • ;--; Is pri.r notj -. Signature: :: - /i Date: 2//4./0 ' The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with •- -fferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfer..e resp'nsibility .�i�iV0". to •nd compl • g h th he A t has read this disclaimer and signs and dates it below. Signature: �.,/ ...a e. f� Date: Z/l6/6 9 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • BUILDER STATEMENT IIIII The signer of this statement does hereby certify that they are the Owners of the •arcel referenced herein,that they are not licensed contractors and that they will b- : ,ing the r-:.i=ns o eGener;� •ntractor f. th= . oposed project. Signatur: ..� ' /I /_t0/ Date: z7 670 9 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New X Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: V2 Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Z. tri Height: XDIndividual System ❑ Repair ❑ Masonry SEP Permit# 94 - 0394 ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: — - �'Public A Os a m N'r F.- o2 Total: 2 Name of System: p 2c" P Afiti5Ot/ 2. If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: I Underground Tank CD‘bove ground Tank Sip.,of Propane Tank: 5Od 6A-t- I Heat Stove I Cook Stove I Woodstove CFireplace Insert UHot Water Tank i Pellet Stove I Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size, distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated 255 � �fj t5 �H Bld App Review: ,. W 2°Floor Heated >� Consistency Review: l(P5_00 Other Heated Base fee: I O g5,35 Mezzanine Additional Section: Heated Basement Plan Check fee: (}g Ia3I. Unheated Basement State Surcharge fee: /! 5Q Other Unheated Pot Water Review fee: Rc C4 ,L,.-a- ic�q 43ob.t a _ 16o•cO Garage/Carport 37 CI�!. SUBTOTAL \ ,I C C' e Decks 911/Rd Approach fee: L Other TOTAL: $ % LI(o 9,,g_ Receipt Number: ,ci34Slc, - Cash/Check Number: 004 ESTIMATED COST(REQUIRED) Ol �bp+g Date: .Fair market value of all labor and materials founda6 e o Ihi h S?a : c Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • ------. 0•1111111111111111111111111111M • NI it . -1, 2 0 ,. (... til -i- , .... () > u s q) D N !-,.,1 I LA - r •/ x 1- ix il 0 I /// \ 141 i 0 > --i . '. GI 11,1 •-' I lt .ti •"?' 1 . . , \N".... ; 4 • 0 i N '1 nh 0 C 1 1.•' \\-e \ Z O til . To1 r, )• tn. 'k. \s.; if% No .\IT '`) A • \ 0 \ •.:,, i rti k)3 c r 1 r ,.... G _ I) 0 7 • rlk ) nl. 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